Quarterly HCPCS Code (J Codes) Update - January 2021

Tuesday, January 12, 2021

Effective with the date of service Jan 1, 2021, the Centers for Medicare & Medicaid Services (CMS) has added new HCPCS codes (J codes), deleted others and changed the description of some existing codes. For complete information regarding all HCPCS codes and descriptions, refer to the 2021 edition of HCPSC Level II, published by Optum.

NC Medicaid and GDIT have completed system updates to align our policies with J code changes (new codes, covered and non-covered, as well as the end-dated codes) to ensure that claims billed with the new codes will process and pay correctly.

Claims submitted with deleted codes will be denied for dates of service on or after Dec. 31, 2020. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code(s).  
 

New HCPCS code covered (effective Jan. 1, 2021)

Description

Brand Name

NDC

Old HCPCS code (Ineffective Dec. 31, 2020)

J0693

Injection, cefiderocol, 5 mg

Fetroja

59630-0266-01

59630-0266-10

J3490

J1823

Injection, inebilizumab-cdon, 1 mg

Uplinza

72677-0551-01

J3590

J9144

Injection, daratumumab, 10 mg and hyaluronidase-fihj

Darzalex Faspro

57894-0503-01

J9999

J9223

Injection, lurbinectedin, 0.1 mg

Zepzelca

68727-0712-01

J9999

J9281

Mitomycin pyelocalyceal instillation, 1 mg

Jelmyto

72493-0101-40

72493-0103-03

J9999

J9316

Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg

Phesgo

50242-0245-01

50242-0260-01

J9999

J9317

Injection, sacituzumab govitecan-hziy, 2.5 mg

Trodelvy

55135-0132-01

J9999

S0013

Esketamine, nasal spray, 1 mg

Spravato

50458-0028-00

50458-0028-02

50458-0028-03

J3490

 

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